Wallis动态稳定系统治疗腰椎退行性疾病52例报告

A clinical analysis of interspinous dynamic stabilization device(Wallis) in patients of degenerative lumbar disease:52 cases report

目的：探讨Wallis系统治疗腰椎退行性疾病的中期临床疗效及适应证。方法回顾性分析2007年5月至2012年3月，应用Wallis棘突间动态稳定系统治疗的腰椎退行性病变共52例，男27例，女25例；年龄38～64岁，平均47.3岁。其中L4～5单节段48例，L4～S1双节段4例，均行腰椎开窗减压Wallis系统置入。观察术前及术后视觉疼痛评分（ visual analogue scale，VAS ）、Oswestry 残障指数评分（ oswestry disability index，ODI ）及下腰痛（ Japanese orthopaedic association，JOA ）评分变化情况，并测量术前及术后病变节段活动范围（rangeofmotion，ROM）及椎间盘后高度（posteriordischeight，PDH）。结果术后随访24～36个月，平均28.3个月。手术时间70～230 min，平均113.2 min。术中出血量20～300 ml，平均82.6 ml。手术节段PDH，术前（7.80±3.2） mm，末次随访时（7.20±0.7） mm，差异无统计学意义（ P=0.09），VAS评分、ODI评分和JOA评分术前分别为：（7.60±1.0、39.0±3.3和17.5±2.4），末次随访分别为：（1.70±0.6、17.7±0.3和25.6±0.7），差异均有统计学意义（ P分别为0.003、0.005和0.007）。1例腰椎间盘突出症患者术后椎间盘突出复发，保守治疗缓解；另1例腰椎管狭窄症患者术后症状改善不明显，改行腰椎全椎板减压椎间融合固定术，症状缓解。其余病例末次随访时未发现假体移位等并发症，随访期间亦未出现节段不稳或邻近节段严重退变。结论应用 Wallis 动态稳定系统治疗腰椎退行性疾病，能保留手术节段腰椎的活动度，中期随访疗效良好，其主要适应证为退变不严重的腰椎管狭窄症。

Objective To explore the interim effects and indications of the treatment of degenerative lumbar disease with Wallis interspinous dynamic stabilization system.Methods From May 2007 to March 2012, a retrospective analysis was done and 52 patients （ 27 males and 25 females ） with an average age of 47.3 years （ range： 38-64 years ） , receiving fenestration and stabilization using Wallis interspinous dynamic stabilization system, were reviewed. Segments involved： 48 cases with single segment at L4-5, 4 cases with double segments at L4-S1. Preoperatively and postoperatively, results of visual analogue scales （ VAS ）, Oswestry disability index （ ODI ） and Japanese orthopaedic association （ JOA ） score were recorded and the range of motion （ ROM ） and posterior disc height （ PDH ） of operated segments were measured.Results 52 patients were followed up with an average of 28.3 months （ range： 24-36 months ）. Mean time of surgery overall was 113.2 minutes （ range： 70-230 mins ）. Average blood loss was 82.6 ml （ range： 20-300 ml ）. The PDH of operated segments was （ 7.80±3.2 ） mm preoperatively, and （ 7.20±0.7 ） mm in the latest follow up. The preoperative VAS score, ODI score and JOA score was 7.60±1.0, 39.0±3.3 and 17.5±2.4 respectively, and 1.70±0.6, 17.7±0.3 and 25.6±0.7 respectively in the latest follow up. In the latest follow up, the PDH of the operative segments had no signiifcant difference compared with that of preoperation （P=0.09 ）. Other data including VAS score, Oswestry score and JOA score were statistically and signiifcantly improved （P=0.003,P=0.005,P=0.007 respectively ）. One patient with prolapse of lumbar intervertebral disc was diagnosed as recurrent herniation after the surgery, who received conservative treatment. Another patient with lumbar stenosis felt slight change after surgery, then the patient underwent extensive laminectomy and interbody fusion. Symptoms were relieved. No complications including prosthesis shift in other patients were found. No segment instability and severe degeneration of adjacent segments were found during the follow-up.Conclusions The clinical outcomes of Wallis in the treatment of degenerative lumbar diseases are satisfactory in the interim stage. The wallis dynamic stabilization system can retain the range of motion of the operated segments. It is a good choice for the treatment of lumbar stenosis without severe degeneration.